WASHINGTON — Congressional Republicans insist they are moving forward on their campaign pledge to repeal and replace Obamacare, but internal divisions over key components mean they will head home for a week-long recess with few details on how they will overhaul the nation’s health care system.
Republicans huddled in the basement of the Capitol for a closed-door meeting Thursday to hear presentations from the two committee leaders leading the effort — Oregon Rep. Greg Walden and Texas Rep. Kevin Brady — who outlined plans to set up tax credits and restructuring how states will administer Medicaid programs that provide coverage for millions.
Members coming out of the meeting continued to stress they were unified on their goal and campaign promise to do away with the Affordable Care Act, but no draft language was handed out. Most members described a more robust discussion of the House GOP’s “Better Way” health care proposal that they campaigned on in 2016.
“This is a complex issue, one of the members said ‘hey you’ve got to keep this simple.’ You can’t keep this simple. When you are talking about health care and rolling back 2,600 pages of the Affordable Care Act this is going to take some complexity,” Republican Rep. Mark Walker, the head of a group of fiscal conservatives, said after the meeting.
Many conservatives, despite the lack of details, said they are confident that there will be a vote in the first quarter of the year — a goal that House Speaker Paul Ryan has set.
But other members said their new target for moving legislation from committees to the House floor was sometime in mid-April.
In recent weeks, town halls in member’s districts have erupted with angry pushback from voters who are uneasy about the Republicans’ plans to transform the health care system.
At Thursday’s meeting, there was a PowerPoint presentation and members were supposed to get paper versions to bring home, but they weren’t ready in time for the meeting. Instead leaders promised to give each member packets with information so they will be armed with some more answers for voters.
A PowerPoint distributed after the meeting included quotes from Americans who had been negatively affected by the Affordable Care Act and included maps of just how much premiums had gone up in individual states and how few options there were in some places. The slide show included a briefing of the three-part plan to give regulatory relief through administrative action, repeal and replace using reconciliation and then move forward with additional legislation.
Michigan Rep. Bill Huizenga told reporters he wasn’t worried they still hasn’t seen a bill from leaders yet, noting that the Democrats’ efforts to design Obamacare took 14 months.
“We knew we haven’t gotten into this overnight,” Huizenga said. “We are not going to get out of it overnight.”
The official cost estimate of the GOP proposal is still a work in progress by the Congressional Budget Office. Members are awaiting the results.
“If it comes back and it’s out of the roof then it might take some more time to figure out how to pay for this,” Walker admitted.
Missouri GOP Rep. Ann Wagner downplayed the fact that leaders didn’t unveil actual legislation, telling reporters “I think we’ve got the outline of things that will be a part of a bill and part of a reconciliation package going along. We have had this in place for some time, and now we’re getting down to some of the very specifics.”
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Newly installed Health and Human Services Secretary Tom Price, who recently resigned his House seat, attended the meeting and pledged “the president is all-in on this.”
But GOP leaders are concerned that the window for action is tight and they are scrambling to corral members around a proposal. The more time they take the more that counter-pressures from the right and left — to speed up or slow down the process — are making their job more difficult. They are using a budget procedure known as reconciliation to repeal major planks of the law and begin the process of replacing it. This process allows them to pass the measure with a simple majority in the Senate. But they want to use a similar strategy for tax reform so they are mindful of the need to get bill moving soon so they can tackle other issues this spring.
Price discussed the need to stick with the timeline the leaders set out. “Let’s not miss this opportunity. Let’s go shoulder to shoulder, arm to arm,” he said.
But multiple members from across the ideological spectrum stressed that a lot of decisions still hadn’t been made on key issues.
“So there’s obviously unanswered questions and — no shocker here — we have differences of opinion even within our conference,” Huizenga told reporters.
Future of Obamacare taxes, Medicaid programs
Committee leaders walked through several policy issues they are working through such as how to design tax credits for those who will be shopping for health care in the new system and how to address how money will flow to states that administer the Medicaid program.
They went over plans for creating high-risk pools and proposals for incentives for broader use of health savings accounts. In the PowerPoint sent out after the meeting, there was a promise to “deliver relief from the Obamacare taxes,” “eliminate the individual and employer mandate penalties,” and “repeal Obamacare spending for the Medicaid expansion and the new open-ended subsidies.”
But in some areas, there was no clear consensus. For example, the details on how states would handle the Medicaid program are still being worked out. Republicans from Medicaid expansion states have been fighting to keep their expansion money and ensure voters back home who were covered under the program could remain on it, but Medicaid has long been a top target for fiscal conservatives looking to make cuts in the budget. There is wide consensus that states need more flexibility in handling their federal Medicaid dollars, but there still are not clear details on whether that flexibility will come through block grants or per capita allotments is still up in the air.
Ways and Means Committee Chairman Brady told reporters that the discussion was also ongoing as to what to do with Obamacare taxes. Conservatives have said the taxes need to be repealed immediately, but others have been arguing that Republicans will need to keep the taxes in place in the short term to fund their own Obamacare replacement.
Rep. Pete Sessions of Texas told reporters that he had no actual budget numbers of how each program- from tax credits to health savings accounts- would be funded, a key factor in whether or not Republicans will be able to rally around the plan.
“They did not overlay the money and that is the big question,” Sessions said. “You cannot pass policy, you have to pass money. It’s about money.”
So far, a leading member of the conservative House Freedom Caucus didn’t sound impressed with what he heard from his leadership.
“So far it just sounds like Obamacare light,” said Idaho Republican Rep. Raul Labrador.